title: Central line maintenance bundles and CLABSIs in ambulatory oncology patients.
abstract: OBJECTIVE
  Pediatric oncology patients are frequently managed with central lines as outpatients, and these lines confer significant morbidity in this immune-compromised population. We aimed to investigate whether a multidisciplinary, central line maintenance care bundle reduces central line-associated bloodstream infections (CLABSIs) and bacteremias in ambulatory pediatric oncology patients.
  
  
  METHODS
  We conducted an interrupted time-series study of a maintenance bundle concerning all areas of central line care. Each of 3 target groups (clinic staff, homecare agency nurses, and patient families) (1) received training on the bundle and its importance, (2) had their practice audited, and (3) were shown CLABSI rates through graphs, in-service training, and bulletin boards. CLABSI and bacteremia person-time incidence rates were collected for 23 months before and 24 months after beginning the intervention and were compared by using a Poisson regression model.
  
  
  RESULTS
  The mean CLABSI rate decreased by 48% from 0.63 CLABSIs per 1000 central line days at baseline to 0.32 CLABSIs per 1000 central line days during the intervention period (P = .005). The mean bacteremia rate decreased by 54% from 1.27 bacteremias per 1000 central line days at baseline to 0.59 bacteremias per 1000 central line days during the intervention period (P < .001).
  
  
  CONCLUSIONS
  Implementation of a multidisciplinary, central line maintenance care bundle significantly reduced CLABSI and bacteremia person-time incidence rates in ambulatory pediatric oncology patients with central lines. Further research is needed to determine if maintenance care bundles reduce ambulatory CLABSIs and bacteremia in other adult and pediatric populations.
authors.affiliation: Department of Pediatrics, The Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY 10467. mrinke@montefiore.org.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Rinke
authors.forename: David G
authors.initials: DG
authors.lastname: Bundy
authors.forename: Allen R
authors.initials: AR
authors.lastname: Chen
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Milstone
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: Miriana
authors.initials: M
authors.lastname: Pehar
authors.forename: Cynthia
authors.initials: C
authors.lastname: Herpst
authors.forename: Lisa
authors.initials: L
authors.lastname: Fratino
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods / Q000592:standards*; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000379:methods / Q000592:standards*; D062905:Central Venous Catheters / Q000382:microbiology / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D016522:Oncology Service, Hospital / Q000592:standards*; D064872:Patient Care Bundles / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult
keywords: central line–associated bloodstream infection; central venous catheter/access device; epidemiology; oncology; outpatient management; pediatric; quality improvement